Up to five years of public health reforms before private insurance not needed

Health Minister Stephen Donnelly has predicted it will take three to five years to reform public health services sufficiently to negate the need for private health insurance.

Sweeping reforms are planned in the coming years to make healthcare free based on need. However, with almost half the population relying on insurance to avoid waiting lists, according to the ESRI, there is a long way to go.

Mr Donnelly has told the Irish Examiner reforms need to offer patients accessibility, meaning an end to spiraling waiting lists; affordability, meaning reducing costs such as prescription charges; and quality, meaning improved standards in treatment.

For many people, affordability also means the promise of getting treated without relying on expensive health insurance.

Mr Donnelly said many changes need to happen under Sláintecare before insurance fades away here.

“In terms of people saying ‘if I get sick, my GP needs to get me access to diagnostics or specialist care’, we certainly need to be a long way there, I would say, within three to five years,” he said.

We have to be ambitious about this, there are hundreds of thousands of people waiting for care. ”

About 900,000 people are on hospital waiting lists which he describes as “unacceptable”.

Some reforms have started. More than 120,000 people had received scans through their GP by late last year under a pandemic measure which is set to continue.

However, Mr Donnelly said, across the board, recruitment is the big challenge.

This was made visible last week when the first of what could be a series of strikes by medical scientists took place over pay.

They are paid less than other workers in their laboratories, with graduates who work as laboratory aides while studying taking a pay cut when they start working as scientists.

Junior doctors, non-consultant hospital doctors (NCHDs), are also balloting for industrial action, saying they regularly work 80-hour weeks in breach of European law.

“There needs to be very significant changes and improvements to their working lives,” said Mr Donnelly. “I think the issues being raised by the NCHDs are absolutely valid.”

Despite these concerns, he insisted vastly increased funding has seen strides taken already towards safe staffing levels with the equivalent of 134,000 full-time staff now in place. He pointed to 14,284 more staff (net) in the health service compared to the start of 2020. This includes 4,100 nurses and midwives, as well as 1,300 doctors and dentists.

As part of the move towards better community care, 2,300 health and social care professionals such as audiologists, speech and language therapists, and physiotherapists have also been recruited.

Regional health areas

At the local level, the focus is on setting up six regional health areas to replace hospital groups and HSE community organizations. Delays to these changes were the focus of senior resignations from the Sláintecare team last year. They are now expected to be “fully operational” during 2024.

“At the same time, what we want to preserve is a much leaner but still a strong central HSE organization,” said Mr Donnelly, adding that Covid-19 vaccinations were a good example of why central powers are still needed.

A crowded shelf next to Mr Donnelly’s desk holds copies of Cancer Strategy (2017 to 2026) and Sharing the Vision for mental health (2020) and other plans launched with much fanfare.

Looking to a time when Covid-19 no longer dominates, he said: “Strategies have got to be funded.” The plan is to fund existing strategies in preference to commissioning new ones where possible. “We have a very clear plan on how to get there, it’s about implementation.”


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